Transition-related care had been excluded from benefits since mid-1990s.

A federal court has ruled that Wisconsin’s refusal to cover the costs of “surgery and sex hormones associated with gender reassignment” for its transgender state employees violates the ban on sex discrimination in Title VII of the 1964 Civil Rights Act and in the Affordable Care Act, as well as the 14th Amendment’s Equal Protection Clause, Gay City News reports.

District Judge William M. Conley had previously awarded a preliminary injunction to transgender Medicaid participants who were seeking similar coverage under that program, having concluded they were likely to prevail on the merits of their claims.

In this new decision on Sept. 18, in a case brought by Alina Boyden and Shannon Andrews, both employees of the University of Wisconsin, Conley granted their motion for summary judgment, so this is a final ruling on liability. There could still be a trial on damages if the state doesn’t settle, Gay City News reports.

Coverage for gender transition hormones and surgery have been excluded from the uniform benefits offered Wisconsin public employees since 1994, when the state concluded that insurance companies generally view them as “experimental and not medically necessary.”

In this case, however, the state argued this exclusion is not total, since hormone treatment for gender dysphoria is covered “unless specifically made a course of treatment leading to or involving gender conforming surgery.” The two sides in the lawsuit, however, disagreed about how this is interpreted and applied in practice, Gay City News reports.

“There is no dispute that mental health counseling as a stand-alone treatment for gender dysphoria is covered, whereas hormone therapy involving gender reassignment surgery is not covered; and there is no dispute that the surgery itself is not covered,” Conley wrote. Also excluded from coverage are “treatment, services, and supplies for cosmetic purposes,” with the state explaining that “psychological reasons do not represent a medical/surgical necessity.”